S.I. No. 112/1954 - Army Pensions (Form of Service Certificate) Regulations, 1954.

1. The deceased was not at any time a member of any organisation to which Part II of the

Army Pensions Act, 1932

, applies.

or

The deceased was a member of............................................................ ............................................................ .....

(State organisation or organisations of which deceased was a member.)

2. The deceased was not engaged in military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923 within the meaning of subsection (1) of

section 5

of the

Army Pensions Act, 1932

or

The deceased was engaged in military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923, within the meaning of subsection (1) of

section 5

of the

Army Pensions Act, 1932

, and the following are particulars of such military service :—

Organisation or organisations of which deceased was a member

Particulars of military service

*Period of service Pre-truce

*Period of service Post-truce

Nature and extent of Military service

From

To

From

To

Oglaigh na h Éireann (Irish Republican Army).

Irish Volunteers

Irish Citizen Army

Fianna Éireann

Hibernian Rifles

Cumann na mBan

* If the service was not continuous throughout, particulars of the period or periods of actual military service should be stated.

3. The deceased did not receive a wound or injury while engaged in military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923.

or

The deceased received a wound or injury while engaged in military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923, and the following are particulars of such wound or injury :—

(a) Nature of wound or injury............................................................ ........................................................

(b) Date on which wound or injury was received............................................................ .................

(c) Circumstances in which wound or injury was received............................................................ .

(d) Particulars of any negligence or misconduct on the part of the deceased which, in the opinion of the Board, should be taken into consideration in determining whether the wound or injury was attributable to

military service............................................................ ............................................................ ......

............................................................ ............................................................ ............

............................................................ ............................................................ ............

4. There is no evidence that the deceased contracted any disease during his military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923.

or

There is evidence that the deceased contracted a disease during his military service in the period beginning on the 1st day of April, 1916, and ending on the 30th day of September, 1923, and the following are the particulars of such evidence :—

(a) Nature of disease............................................................ ............................................................ ...............

............................................................ ............................................................ ................

(b) Actual conditions under which deceased performed his military service............................................................ ............................................................ ..........................

............................................................ ............................................................ ...............................

(c) Particulars of any illness from which the deceased suffered during his military service............................................................ ............................................................ .............................

............................................................ ............................................................ .......................................

(d) Detailed report on the applicant's statements to questions 7 (d) (i) and

(ii) of the application form............................................................ ..................................................

............................................................ ..................................................

(e) Full particulars of any negligence or misconduct on the part of the deceased which, in the opinion of the Board, should be taken into consideration in determining whether the disease was attributable

to military service............................................................ ............................................................ ..

5. Deceased died on the .........................................................day of ............................................................ ........

6. The deceased was not killed before the 1st day of October, 1923, while engaged in military service,

or

The deceased was killed before the 1st day of October, 1923, while engaged in military service and the following are the particulars of the date, place and manner of his death :—

............................................................ ............................................................ ............................................................ ........

............................................................ ............................................................ ............................................................ ........

............................................................ ............................................................ ............................................................ ........

* 7. ............................................................ ..................................

............................................................ ...................................

............................................................ ....................................

*This paragraph will be used for certifying such other particulars in respect of the deceased as the Minister may request the Military Service Registration Board to ascertain and certify.

Signed

.......................................................Chairman

of Military Service Registration Board

.......................................................Member

.......................................................Member

Dated this ............................................day of.......................................................... 19...

_____________________________________________________________________

GIVEN under my Official Seal, this 19th day of May, 1954.

(Signed) OSCAR TRAYNOR,

Minister for Defence.

S.I. No. 112 of 1954.

ARMY PENSIONS (FORM OF SERVICE CERTIFICATE) REGULATIONS, 1954.

I, OSCAR TRAYNOR, Minister for Defence, in exercise of the power conferred on me by subsection (2) of

section 9

of the

Army Pensions Act, 1953

(No. 23 of 1953), and of every and any other power me in this behalf enabling, hereby make the following regulations :—